6.1 Limitations of the research
The impact of health literacy
The potential for health literacy interventions to improve the prevention and management of skin infections must be seen within the context of socio-economic factors that contribute to increased rates of infection (such as household crowding, poor diet and the affordability of health care and medical supplies). Health literacy is not a panacea for all health issues. However it is important that low health literacy be removed as a barrier to providing and accessing adequate health care and making appropriate health care decisions.
The parents and caregivers who participated
Parents and caregivers from three low decile schools were invited to small focus group discussions about skin conditions with the researchers. The majority of parents and caregivers who attended the focus groups had children who suffer from eczema. These participants were particularly interested in skin health because of their ongoing management of eczema and the ever-present threat of infection. The participants were more likely to regularly check children’s skin for eczema and quickly identify when eczema became infected. As such, their behaviour in relation to monitoring skin health of children may not be typical of all parents and caregivers. At the same time, the participants did not demonstrate more knowledge about other skin infections than other people who participated in the focus groups, and so the resources developed in the project include information that is relevant to all parents and caregivers.
The health practitioners who participated
The majority of health practitioners interviewed or who responded to surveys came from Auckland, Counties Manukau and Waitemata DHBs. This may be because the researchers were primarily based in Auckland and actively promoted the project through their local health networks. This could be considered a limitation for the project because it does not reflect a national situation. However each of these DHBs have identified high rates of skin infection amongst children, high rates of hospitalisation for skin infections, and two of the DHBs serve rural as well as urban communities.
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The lack of literature about health literacy and skin infections
An initial search for literature specific to skin infections and health literacy (for adults or children) produced no relevant results. There is also little research specific to the health literacy of children, or interventions to improve child health outcomes for children of parents with low literacy (Sanders et al 2009; Yin et al 2007). Due to a lack of research specific to the project topic, separate literature reviews were undertaken in relation to: the causes of skin infections and potential interventions amongst children and adults; health literacy research focused on adults; and access to primary health care for adults and families. The results of these reviews informed the resources developed within the project. However the project was more reliant on the ideas and feedback of parents and caregivers, health practitioners, teachers and the Reference Group when identifying potential health literacy interventions that might be effective.